Men urged to consider prostate cancer pill

For the first time, leading medical groups are advising millions of healthy men who are regularly screened for prostate cancer to consider taking a drug to prevent the disease.

The advice stops short of saying men should take the drug finasteride, sold in generic form and as Proscar. It is widely used for urinary problems from enlarged prostates as men age.

However, it has not been widely prescribed as a cancer preventive, and it may carry some risks. The new guidance tells men to talk to their doctors and decide for themselves if the good outweighs the bad.

This advice is bound to be confusing, doctors admit. For one thing, it doesn't apply to men who choose not to have screening with PSA blood tests, which no major medical groups recommend.

In men who are regularly screened, finasteride has been shown to cut the odds of being diagnosed with prostate cancer by about 25 percent.

“If a man is interested enough in being screened, then at least he ought to have the benefits of a discussion” about taking the drug, said Dr. Barnett Kramer, a National Institutes of Health scientist and one of the authors of the new guidelines.

They were published in two medical journals and discussed in a news briefing yesterday in connection with a cancer conference in Florida. They were written by doctors with the American Society of Clinical Oncology and the American Urological Association.

Cost could be a big issue for many men. Finasteride, which must be taken daily, costs $2 to $3 a pill and insurers might not cover it for cancer prevention.

“I don't know how big of a place this is going to have in my practice,” said Dr. Thomas Jones in Escondido, a urologist with the Palomar Pomerado Health system. “This is really an off-label use for Proscar. I have not recommended the drug to any of my patients as a prevention tool for prostate cancer.”

Jones said he would be personally reticent to take the pill for the rest of his life.

Well under 10 percent of men in the age groups at risk of developing prostate cancer take finasteride on a preventive basis, said Dr. Christopher Kane, professor and chief of urology at the University of California San Diego Medical Center and the Moores Cancer Center.

“I would tell my patients that every intervention has risks and benefits,” Kane said. “The risk of having prostate cancer in the general population of men is low, so you have to determine whether you're willing to pay the money for the drug and to take it daily for years.”

Kane said preventive use of finasteride could make sense for certain patients, such as those with a family history of the disease and African-American men, who have higher incidence and death rates for prostate cancer.

About 186,000 American men this year will be told they have cancer of the prostate. The disease often is diagnosed from a biopsy after a suspicious PSA blood test, which measures a protein. PSA can be high for many reasons, and there's no proof that screening saves lives – the reason no major cancer groups recommend it.